Training Course on New Technologies of Agricultural

Engineering & Agro – Processing for Developing

Countries

APPLICATION FORM
(Please type)
Name: Family Name ___Yahya______________
Given Name ____Ismun______________
Gender: M PHOTO
(insert in jpg 4*3.5cm)

Date and Place of birth (D/M/Y): _24/05/1964_/ Mandi Aur_______________

Nationality:__Indonesia____________ Religion:__Moeslem______
Occupation: _Postgraduated Student__ Married Status:__Married_
Organization (full name): _University of Muhammadiyah Palembang________
nd
Title (post):_Postgraduated Student (2 Semester)________________________
Postal Address:_Citra Damai 1 Residence, Sapta Marga Street Bloc E No.6
RT.37/RW.08, Bukit Sangkal, Kalidoni, Palembang, Sumatera_Selatan_ Zip
Code__30114_____
Tel: _+62811744963__Fax _____ Valid E-Mail _ismun082177060202@gmail.com
Passport No. _B6264073_______ Valid up to __13 february 2022______
Place of Issue (Province/State, Country): _PALEMBANG________________
Language ability: English (Excellent, good, fair, poor)
Read Write Oral Communicate
(Good)___(Fair)_____(Fair)________(Fair)___________________________

Education (name of university or equivalent, degree obtained and major study)

University of Muhammadiyah Palembang, Bachelor, Chemical Engineering

Work experiences (short summary of professional work, including research project

undertaken)
Deputy General Manager of Waste Water Treatment Plant on PT. Lontar Papyrus
Pulp & Paper Industry, Jambi, Indonesia

Present Status (Name and address of the current employer)

___Agricultural Entrepreneur (Rubber Plantation)________________________
Any requirement to the course
Signature of applicant___________________________

Date _____04 SEPTEMBER 2018_________________________

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Supplement

Education Degree: Doctor □ Master□ Bachelor  Technical or Others□

Education Major: __Chemical Engineering/Process Technology_____
Passport Type: ____e-passport_______________

Date of Issue of Passport (YYYY-MM-DD)：_2017 February

13__________________
Education Degree: __Bachelor_________________
Education Major: __Chemical Engineering/Process Technology_____
Name of Your Employer or School: University of Muhammadiyah Palembang
Daytime Phone Number: ___+62811744963____
Nighttime Phone Number: ___+62811744963___

A Brief Introduction to your Employer or School (within 400 characters)：

Muhammadiyah University of Palembang is one of the private universities
under the auspices Persyarikatan Muhammadiyah was established on 15 June
1979. It located on Jl. Jend. Ahmad Yani No. 13, Seberang Ulu I, Palembang. In
1984, the Faculty of Engineering received Status Registered with the Decree of
the Minister of Education and Culture number 090/0/1984 March 9, 1984. In
1989, the Faculty of Engineering to get improvement of the status of Registered
status into Status Recognized by the Decree of the Minister of Education and
Culture of numbers 0481/0/1989 dated August 1, 1989. in 1992 the Faculty of
Engineering got the improvement of the status of Recognized Status Status
Lumped into the Decree of the Director General of Higher Education Ministry of
Education and Culture No. 329 / Dikti / Kep / 1992 dated August 11, 1992.
Fourth Program in the Faculty of Engineering has received accredited status
from the National Accreditation Board of Higher Education Ministry of
Education. Study Program in Civil Engineering and Chemical Engineering with
the Decree No. 001 / BAN-PT / Ak-II / VIII / 1998 dated August 11, 1998,
Electrical Engineering Program by the Decree No. 004 / BAN-PT / Ak-IV / IV /
2000 on 23 April 2000 and Architectural Engineering Program with the Decree
No. 017 / BAN-PT / Ak-IV / IV / 2000 dated 23 July 2000. In its development of
Study Program Chemical Engineering Program by the Decree No. 016 / BAN-
PT / Ak -XII / S1 / VI / 2009 dated June 26, 2009 to get the accreditation status C.

A Brief Introduction to your Responsibilities (within 400 characters):

 I’m a magister student in chemical engineering at University of
Muhammadiyah Palembang whose has an interest in agriculture. From my point
of view, my country has a big potential to develop the agricultural sector but still
has many limitations in processing it into a nice output. By joining the training
about agricultural

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engineering and agro-process, I’m hoping that I can have a deeper understanding
about how to improve the agricultural business in my country.

How many times have you participated in training workshop in China?

To be detailed
I never participated in any training workshop in China before.

Please copy your ID photo and the first page of your passport (with name,
birth, photo) here. (Readable resolution requested)
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